1st Engrossment - 90th Legislature, 2017 1st Special Session (2017 - 2017) Posted on 06/07/2017 11:15am
A bill for an act
relating to state government; establishing the health and human services budget;
modifying provisions governing community supports, housing, continuing care,
health care, health insurance, direct care and treatment, children and families,
chemical and mental health services, Department of Human Services operations,
Health Department, health licensing boards, opiate abuse prevention, managed
care organizations, and child care development block grant compliance; making
technical changes; modifying terminology and definitions; establishing licensing
fix-it tickets; requiring reports; establishing moratorium on conversion transactions;
modifying fees; making forecast adjustments; appropriating money; amending
Minnesota Statutes 2016, sections 3.972, by adding subdivisions; 13.32, by adding
a subdivision; 13.46, subdivisions 1, 2; 13.84, subdivision 5; 62A.04, subdivision
1; 62A.21, subdivision 2a; 62A.3075; 62D.105; 62E.04, subdivision 11; 62E.05,
subdivision 1; 62E.06, by adding a subdivision; 62K.15; 62U.02; 103I.005,
subdivisions 2, 2a, 12, 20a, 21, by adding subdivisions; 103I.101, subdivisions 2,
5, 6; 103I.105; 103I.111, subdivisions 6, 8; 103I.205, subdivisions 1, 2, 3, 4, 5, 6;
103I.208, subdivisions 1, 2; 103I.235, by adding a subdivision; 103I.301,
subdivisions 1, 2; 103I.315, subdivision 1; 103I.501; 103I.505, subdivisions 1, 2;
103I.515; 103I.525, subdivisions 1, 2, 5, 6, 8; 103I.531, subdivisions 2, 5; 103I.535,
subdivisions 2, 6; 103I.541, subdivisions 1, 2, 2a, 2b, 2c, 2e, 3, 4, 5; 103I.545;
103I.601, subdivisions 2, 4; 103I.711, subdivision 1; 103I.715, subdivision 2;
119B.011, subdivisions 20, 20a; 119B.025, subdivision 1, by adding subdivisions;
119B.03, subdivision 3; 119B.05, subdivision 1; 119B.09, subdivisions 1, 4;
119B.10, subdivision 1, by adding a subdivision; 119B.12, subdivision 2; 119B.13,
subdivisions 1, 6; 144.0722, subdivision 1, as amended; 144.0724, subdivisions
4, 6; 144.122; 144.1501, subdivision 2; 144.4961, subdivisions 3, 4, 5; 144.551,
subdivision 1; 144.562, subdivision 2; 144.99, subdivision 1; 144A.071,
subdivisions 3, as amended, 4a, as amended, 4c, as amended, 4d, as amended;
144A.10, subdivision 4, as amended; 144A.351, subdivision 1; 144A.472,
subdivision 7; 144A.4799, subdivision 3; 144A.70, subdivision 6, by adding a
subdivision; 144A.74; 144D.04, subdivision 2, by adding a subdivision; 144D.06;
145.4131, subdivision 1; 145.4716, subdivision 2; 145.928, subdivision 13; 145.986,
subdivision 1a; 146B.02, subdivisions 2, 3, 5, 8, by adding subdivisions; 146B.03,
subdivisions 6, 7, as amended; 146B.07, subdivision 2; 146B.10, subdivisions 1,
2, by adding a subdivision; 147.01, subdivision 7; 147.02, subdivision 1; 147.03,
subdivision 1; 147B.08, by adding a subdivision; 147C.40, by adding a subdivision;
148.514, subdivision 1; 148.519, subdivisions 1, 2; 148.5194, subdivisions 2, 3,
4, 7, by adding a subdivision; 148.5195, subdivision 2; 148.6402, subdivision 4;
148.6405; 148.6408, subdivision 2; 148.6410, subdivision 2; 148.6412, subdivision
2; 148.6415; 148.6418, subdivisions 1, 2, 4, 5; 148.6420, subdivisions 1, 3, 5;
148.6423; 148.6425, subdivisions 2, 3; 148.6428; 148.6443, subdivisions 5, 6, 7,
8; 148.6445, subdivisions 1, 10; 148.6448; 148.881; 148.89; 148.90, subdivisions
1, 2; 148.905, subdivision 1; 148.907, subdivisions 1, 2; 148.9105, subdivisions
1, 4, 5; 148.916, subdivisions 1, 1a; 148.925; 148.96, subdivision 3; 148.997,
subdivision 1; 148B.53, subdivision 1; 150A.06, subdivisions 3, 8; 150A.10,
subdivision 4; 151.212, subdivision 2; 152.11, by adding a subdivision; 152.25,
subdivision 1, by adding subdivisions; 152.28, by adding a subdivision; 152.33,
by adding a subdivision; 153A.14, subdivisions 1, 2; 153A.17; 157.16, subdivisions
1, 3, 3a; 214.01, subdivision 2; 245.462, subdivision 9; 245.467, subdivision 2;
245.4871, by adding subdivisions; 245.4876, subdivision 2; 245.4889, subdivision
1; 245.814, by adding a subdivision; 245.91, subdivisions 4, 6; 245.94, subdivision
1; 245.97, subdivision 6; 245A.02, subdivisions 2b, 5a, by adding subdivisions;
245A.03, subdivisions 2, 7; 245A.04, subdivisions 4, 14; 245A.06, subdivisions
2, 8, by adding a subdivision; 245A.07, subdivision 3; 245A.09, subdivision 7;
245A.10, subdivision 2; 245A.11, by adding subdivisions; 245A.14, by adding a
subdivision; 245A.16, subdivision 1, by adding a subdivision; 245A.191; 245A.40,
by adding a subdivision; 245A.50, subdivision 5; 245C.02, by adding a subdivision;
245C.03, subdivision 1, by adding a subdivision; 245C.04, subdivisions 1, 8;
245C.05, subdivisions 2b, 4, 5, 7; 245C.08, subdivisions 1, 2, 4; 245C.09, by
adding a subdivision; 245C.10, subdivision 9, by adding subdivisions; 245C.11,
subdivision 3; 245C.15; 245C.16, subdivision 1; 245C.17, subdivision 6; 245C.21,
subdivision 1; 245C.22, subdivisions 5, 7; 245C.23; 245C.24, subdivision 3;
245C.25; 245C.30, subdivision 2; 245D.03, subdivision 1; 245D.04, subdivision
3; 246.18, subdivision 4, by adding a subdivision; 252.27, subdivision 2a; 252.41,
subdivision 3; 252.50, subdivision 5; 253B.10, subdivision 1; 254A.01; 254A.02,
subdivisions 2, 3, 5, 6, 8, 10, by adding subdivisions; 254A.03; 254A.035,
subdivision 1; 254A.04; 254A.08; 254A.09; 254A.19, subdivision 3; 254B.01,
subdivision 3, by adding a subdivision; 254B.03, subdivision 2; 254B.04,
subdivisions 1, 2b; 254B.05, subdivisions 1, 1a, 5; 254B.051; 254B.07; 254B.08;
254B.09; 254B.12, subdivision 2, by adding a subdivision; 254B.13, subdivision
2a; 256.01, by adding a subdivision; 256.045, subdivisions 3, 3a; 256.9657,
subdivision 1; 256.9685, subdivisions 1, 1a; 256.9686, subdivision 8; 256.969,
subdivisions 1, 2b, 3a, 8, 8c, 9, 12; 256.9695, subdivision 1; 256.975, subdivision
7, by adding a subdivision; 256B.04, subdivisions 12, 24; 256B.056, subdivisions
3b, 3c, 5c; 256B.0561, subdivisions 2, 4; 256B.057, subdivision 9, as amended;
256B.059, subdivision 6, as amended; 256B.0621, subdivision 10; 256B.0625,
subdivisions 1, 3b, 6a, 7, 17, 17b, 18h, 20, 31, 45a, 64, by adding subdivisions;
256B.0644; 256B.0653, subdivisions 2, 3, 4, as amended, 5, 6, by adding a
subdivision; 256B.072; 256B.0755, subdivisions 1, 3, 4, by adding a subdivision;
256B.0911, subdivisions 1a, 2b, 3a, 4d, as amended, 5, 6, as amended, by adding
a subdivision; 256B.0915, subdivisions 1, 3a, 3e, 3h, 5, by adding subdivisions;
256B.092, subdivision 4; 256B.0921; 256B.0924, by adding a subdivision;
256B.0943, subdivision 13; 256B.0945, subdivisions 2, 4; 256B.196, subdivisions
2, 3, 4; 256B.35, subdivision 4, as amended; 256B.431, subdivisions 10, 16, 30;
256B.434, subdivisions 4, 4f; 256B.49, subdivisions 11, 15; 256B.4913, subdivision
4a, by adding a subdivision; 256B.4914, subdivisions 2, 3, 5, 6, 7, 8, 9, 10, 16, by
adding a subdivision; 256B.493, subdivisions 1, 2, by adding a subdivision;
256B.50, subdivision 1b; 256B.5012, by adding subdivisions; 256B.69, subdivision
9e, by adding subdivisions; 256B.75; 256B.76, subdivisions 1, as amended, 2;
256B.761; 256B.763; 256B.766; 256C.21; 256C.23, subdivisions 1, 2, by adding
subdivisions; 256C.233, subdivisions 1, 2, 4; 256C.24; 256C.25, subdivision 1;
256C.261; 256C.30; 256D.44, subdivisions 4, as amended, 5, as amended; 256E.30,
subdivision 2; 256I.03, subdivision 8; 256I.04, subdivisions 1, 2d, 2g, 3; 256I.05,
subdivisions 1a, 1c, 1e, 1j, 1m, by adding subdivisions; 256I.06, subdivisions 2,
8; 256J.45, subdivision 2; 256L.03, subdivisions 1, 1a, 5; 256L.11, subdivision 7,
by adding a subdivision; 256L.15, subdivision 2; 256P.06, subdivision 2; 256P.07,
subdivisions 3, 6; 256R.02, subdivisions 4, 17, 18, 19, 22, 42, 52, by adding
subdivisions; 256R.06, subdivision 5; 256R.07, by adding a subdivision; 256R.10,
by adding a subdivision; 256R.37; 256R.40, subdivisions 1, 5; 256R.41; 256R.47;
256R.49, subdivision 1; 260C.451, subdivision 6; 327.15, subdivision 3; 364.09;
609.5315, subdivision 5c; 626.556, subdivisions 2, 3, 3c, 4, 10d, 10e, 10f, 10i;
Laws 2009, chapter 101, article 1, section 12; Laws 2012, chapter 247, article 4,
section 47, as amended; article 6, section 2, subdivision 2; Laws 2013, chapter
108, article 15, section 2, subdivision 2; Laws 2015, chapter 71, article 14, section
3, subdivision 2, as amended; Laws 2017, chapter 2, article 1, sections 2,
subdivision 3; 5; 7; Laws 2017, chapter 13, article 1, section 15; proposing coding
for new law in Minnesota Statutes, chapters 103I; 119B; 137; 144; 147A; 148;
245; 245A; 256; 256B; 256I; 256N; 256R; proposing coding for new law as
Minnesota Statutes, chapters 144H; 245G; repealing Minnesota Statutes 2016,
sections 13.468; 103I.005, subdivisions 8, 14, 15; 103I.451; 119B.07; 144.0571;
144A.351, subdivision 2; 147A.21; 147B.08, subdivisions 1, 2, 3; 147C.40,
subdivisions 1, 2, 3, 4; 148.6402, subdivision 2; 148.6450; 148.906; 148.907,
subdivision 5; 148.908; 148.909, subdivision 7; 148.96, subdivisions 4, 5;
245A.1915; 245A.192; 254A.02, subdivision 4; 256B.19, subdivision 1c;
256B.4914, subdivision 16; 256B.64; 256B.7631; Laws 2012, chapter 247, article
4, section 47, as amended; Laws 2015, chapter 71, article 7, section 54; Minnesota
Rules, parts 5600.2500; 9500.1140, subparts 3, 4, 5, 6; 9530.6405, subparts 1, 1a,
2, 3, 4, 5, 6, 7, 7a, 8, 9, 10, 11, 12, 13, 14, 14a, 15, 15a, 16, 17, 17a, 17b, 17c, 18,
20, 21; 9530.6410; 9530.6415; 9530.6420; 9530.6422; 9530.6425; 9530.6430;
9530.6435; 9530.6440; 9530.6445; 9530.6450; 9530.6455; 9530.6460; 9530.6465;
9530.6470; 9530.6475; 9530.6480; 9530.6485; 9530.6490; 9530.6495; 9530.6500;
9530.6505.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2016, section 144A.351, subdivision 1, is amended to read:
The commissioners of health and human services,
with the cooperation of counties and in consultation with stakeholders, including persons
who need or are using long-term care services and supports, lead agencies, regional entities,
senior, disability, and mental health organization representatives, service providers, and
community members shall prepare a report to the legislature by August 15, 2013, and
biennially thereafter, regarding the status of the full range of long-term care services and
supports for the elderly and children and adults with disabilities and mental illnesses in
Minnesota.new text begin Any amounts appropriated for this report are available in either year of the
biennium.new text end The report shall address:
(1) demographics and need for long-term care services and supports in Minnesota;
(2) summary of county and regional reports on long-term care gaps, surpluses, imbalances,
and corrective action plans;
(3) status of long-term care services and related mental health services, housing options,
and supports by county and region including:
(i) changes in availability of the range of long-term care services and housing options;
(ii) access problems, including access to the least restrictive and most integrated services
and settings, regarding long-term care services; and
(iii) comparative measures of long-term care services availability, including serving
people in their home areas near family, and changes over time; and
(4) recommendations regarding goals for the future of long-term care services and
supports, policy and fiscal changes, and resource development and transition needs.
Minnesota Statutes 2016, section 245D.03, subdivision 1, is amended to read:
(a) The commissioner shall regulate the provision of home
and community-based services to persons with disabilities and persons age 65 and older
pursuant to this chapter. The licensing standards in this chapter govern the provision of
basic support services and intensive support services.
(b) Basic support services provide the level of assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
person. Basic support services include:
(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental disability, and elderly waiver plans, excluding
out-of-home respite care provided to children in a family child foster care home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8,
or successor provisions; and section 245D.061 or successor provisions, which must be
stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000,
subpart 4;
(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
(3) personal support as defined under the developmental disability waiver plan;
(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental disability waiver plans;
(5) night supervision services as defined under the brain injury waiver plan; deleted text begin and
deleted text end
(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental disability, and elderly waiver plans,
excluding providers licensed by the Department of Health under chapter 144A and those
providers providing cleaning services onlynew text begin ; and
new text end
new text begin (7) individual community living support under section 256B.0915, subdivision 3jnew text end .
(c) Intensive support services provide assistance, supervision, and care that is necessary
to ensure the health and welfare of the person and services specifically directed toward the
training, habilitation, or rehabilitation of the person. Intensive support services include:
(1) intervention services, including:
(i) behavioral support services as defined under the brain injury and community access
for disability inclusion waiver plans;
(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and
(iii) specialist services as defined under the current developmental disability waiver
plan;
(2) in-home support services, including:
(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;
(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans; deleted text begin and
deleted text end
(iii) semi-independent living services;new text begin and
new text end
new text begin
(iv) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion waiver plans;
new text end
(3) residential supports and services, including:
(i) supported living services as defined under the developmental disability waiver plan
provided in a family or corporate child foster care residence, a family adult foster care
residence, a community residential setting, or a supervised living facility;
(ii) foster care services as defined in the brain injury, community alternative care, and
community access for disability inclusion waiver plans provided in a family or corporate
child foster care residence, a family adult foster care residence, or a community residential
setting; and
(iii) residential services provided to more than four persons with developmental
disabilities in a supervised living facility, including ICFs/DD;
(4) day services, including:
(i) structured day services as defined under the brain injury waiver plan;
(ii) day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disability waiver plan; and
(iii) prevocational services as defined under the brain injury and community access for
disability inclusion waiver plans; and
(5) deleted text begin supported employment as defined under the brain injury, developmental disability,
and community access for disability inclusion waiver plansdeleted text end new text begin employment exploration services
as defined under the brain injury, community alternative care, community access for disability
inclusion, and developmental disability waiver plans;
new text end
new text begin
(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans; and
new text end
new text begin (7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plansnew text end .
new text begin
(a) The amendment to paragraphs (b) and (c), clause (2), is
effective the day following final enactment.
new text end
new text begin
(b) The amendments to paragraph (c), clauses (5) to (7), are effective upon federal
approval. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end
Minnesota Statutes 2016, section 252.41, subdivision 3, is amended to read:
new text begin (a) new text end "Day training and habilitation services for adults with developmental
disabilities" means services that:
(1) include supervision, training, assistance, deleted text begin and supported employment,deleted text end new text begin center-basednew text end
work-related activities, or other community-integrated activities designed and implemented
in accordance with the individual service and individual habilitation plans required under
Minnesota Rules, parts 9525.0004 to 9525.0036, to help an adult reach and maintain the
highest possible level of independence, productivity, and integration into the community;
and
(2) are provided by a vendor licensed under sections 245A.01 to 245A.16 and 252.28,
subdivision 2, to provide day training and habilitation services.
new text begin (b) new text end Day training and habilitation services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.
new text begin
(c) Day training and habilitation services do not include employment exploration,
employment development, or employment support services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.
new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
new text begin
(a) The commissioner shall make available a grant for the purposes of establishing and
maintaining a statewide self-advocacy network for persons with intellectual and
developmental disabilities. The self-advocacy network shall:
new text end
new text begin
(1) ensure that persons with intellectual and developmental disabilities are informed of
their rights in employment, housing, transportation, voting, government policy, and other
issues pertinent to the intellectual and developmental disability community;
new text end
new text begin
(2) provide public education and awareness of the civil and human rights issues persons
with intellectual and developmental disabilities face;
new text end
new text begin
(3) provide funds, technical assistance, and other resources for self-advocacy groups
across the state; and
new text end
new text begin
(4) organize systems of communications to facilitate an exchange of information between
self-advocacy groups.
new text end
new text begin
(b) An organization receiving a grant under paragraph (a) must be an organization
governed by people with intellectual and developmental disabilities that administers a
statewide network of disability groups in order to maintain and promote self-advocacy
services and supports for persons with intellectual and developmental disabilities throughout
the state.
new text end
Minnesota Statutes 2016, section 256B.0625, subdivision 6a, is amended to read:
Home health services are those services specified in
Minnesota Rules, part 9505.0295 and sections 256B.0651 and 256B.0653. Medical assistance
covers home health services at a recipient's home residencenew text begin or in the community where
normal life activities take the recipientnew text end . Medical assistance does not cover home health
services for residents of a hospital, nursing facility, or intermediate care facility, unless the
commissioner of human services has authorized skilled nurse visits for less than 90 days
for a resident at an intermediate care facility for persons with developmental disabilities,
to prevent an admission to a hospital or nursing facility or unless a resident who is otherwise
eligible is on leave from the facility and the facility either pays for the home health services
or forgoes the facility per diem for the leave days that home health services are used. Home
health services must be provided by a Medicare certified home health agency. All nursing
and home health aide services must be provided according to sections 256B.0651 to
256B.0653.
Minnesota Statutes 2016, section 256B.0625, subdivision 31, is amended to read:
(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.
(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.
(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:
(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;
(2) the vendor serves ten or fewer medical assistance recipients per year;
(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and
(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.
(d) Durable medical equipment means a device or equipment that:
(1) can withstand repeated use;
(2) is generally not useful in the absence of an illness, injury, or disability; and
(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.
(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.
(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.
new text begin
(g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 440.70.
new text end
Minnesota Statutes 2016, section 256B.0653, subdivision 2, is amended to read:
For the purposes of this section, the following terms have the
meanings given.
(a) "Assessment" means an evaluation of the recipient's medical need for home health
agency services by a registered nurse or appropriate therapist that is conducted within 30
days of a request.
(b) "Home care therapies" means occupational, physical, and respiratory therapy and
speech-language pathology services provided in the home by a Medicare certified home
health agency.
(c) "Home health agency services" means services delivered deleted text begin in the recipient's home
residence, except as specified in section 256B.0625,deleted text end by a home health agency to a recipient
with medical needs due to illness, disability, or physical conditionsnew text begin in settings permitted
under section 256B.0625, subdivision 6anew text end .
(d) "Home health aide" means an employee of a home health agency who completes
medically oriented tasks written in the plan of care for a recipient.
(e) "Home health agency" means a home care provider agency that is Medicare-certified.
(f) "Occupational therapy services" mean the services defined in Minnesota Rules, part
9505.0390.
(g) "Physical therapy services" mean the services defined in Minnesota Rules, part
9505.0390.
(h) "Respiratory therapy services" mean the services defined in chapter 147C.
(i) "Speech-language pathology services" mean the services defined in Minnesota Rules,
part 9505.0390.
(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
required due to a recipient's medical condition that can only be safely provided by a
professional nurse to restore and maintain optimal health.
(k) "Store-and-forward technology" means telehomecare services that do not occur in
real time via synchronous transmissions such as diabetic and vital sign monitoring.
(l) "Telehomecare" means the use of telecommunications technology via live, two-way
interactive audiovisual technology which may be augmented by store-and-forward
technology.
(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to deliver
a skilled nurse visit to a recipient located at a site other than the site where the nurse is
located and is used in combination with face-to-face skilled nurse visits to adequately meet
the recipient's needs.
Minnesota Statutes 2016, section 256B.0653, subdivision 3, is amended to read:
(a) Home health aide visits must be provided by a
certified home health aide using a written plan of care that is updated in compliance with
Medicare regulations. A home health aide shall provide hands-on personal care, perform
simple procedures as an extension of therapy or nursing services, and assist in instrumental
activities of daily living as defined in section 256B.0659, including assuring that the person
gets to medical appointments if identified in the written plan of care. Home health aide
visits deleted text begin mustdeleted text end new text begin maynew text end be provided in the recipient's homenew text begin or in the community where normal life
activities take the recipientnew text end .
(b) All home health aide visits must have authorization under section 256B.0652. The
commissioner shall limit home health aide visits to no more than one visit per day per
recipient.
(c) Home health aides must be supervised by a registered nurse or an appropriate therapist
when providing services that are an extension of therapy.
Minnesota Statutes 2016, section 256B.0653, subdivision 4, as amended by Laws
2017, chapter 59, section 10, is amended to read:
(a) Skilled nurse visit services must be provided
by a registered nurse or a licensed practical nurse under the supervision of a registered nurse,
according to the written plan of care and accepted standards of medical and nursing practice
according to chapter 148. Skilled nurse visit services must be ordered by a physician,
advanced practice registered nurse, or physician assistant and documented in a plan of care
that is reviewed and approved by the ordering physician, advanced practice registered nurse,
or physician assistant at least once every 60 days. All skilled nurse visits must be medically
necessary and provided in the recipient's home residence new text begin or in the community where normal
life activities take the recipient,new text end new text begin new text end except as allowed under section 256B.0625, subdivision
6a.
(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of up
to two visits per day per recipient. All visits must be based on assessed needs.
(c) Telehomecare skilled nurse visits are allowed when the recipient's health status can
be accurately measured and assessed without a need for a face-to-face, hands-on encounter.
All telehomecare skilled nurse visits must have authorization and are paid at the same
allowable rates as face-to-face skilled nurse visits.
(d) The provision of telehomecare must be made via live, two-way interactive audiovisual
technology and may be augmented by utilizing store-and-forward technologies. Individually
identifiable patient data obtained through real-time or store-and-forward technology must
be maintained as health records according to sections 144.291 to 144.298. If the video is
used for research, training, or other purposes unrelated to the care of the patient, the identity
of the patient must be concealed.
(e) Authorization for skilled nurse visits must be completed under section 256B.0652.
A total of nine face-to-face skilled nurse visits per calendar year do not require authorization.
All telehomecare skilled nurse visits require authorization.
Minnesota Statutes 2016, section 256B.0653, subdivision 5, is amended to read:
(a) Home care therapies include the following: physical
therapy, occupational therapy, respiratory therapy, and speech and language pathology
therapy services.
(b) Home care therapies must be:
(1) provided in the recipient's residencenew text begin or in the community where normal life activities
take the recipientnew text end after it has been determined the recipient is unable to access outpatient
therapy;
(2) prescribed, ordered, or referred by a physician and documented in a plan of care and
reviewed, according to Minnesota Rules, part 9505.0390;
(3) assessed by an appropriate therapist; and
(4) provided by a Medicare-certified home health agency enrolled as a Medicaid provider
agency.
(c) Restorative and specialized maintenance therapies must be provided according to
Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be used
as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
(d) For both physical and occupational therapies, the therapist and the therapist's assistant
may not both bill for services provided to a recipient on the same day.
Minnesota Statutes 2016, section 256B.0653, subdivision 6, is amended to read:
The following are not eligible for
payment under medical assistance as a home health agency service:
(1) telehomecare skilled nurses services that is communication between the home care
nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
mail, or a consultation between two health care practitioners;
(2) the following skilled nurse visits:
(i) for the purpose of monitoring medication compliance with an established medication
program for a recipient;
(ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient or a family member is physically and mentally able to
self-administer or prefill a medication;
(iii) services done for the sole purpose of supervision of the home health aide or personal
care assistant;
(iv) services done for the sole purpose to train other home health agency workers;
(v) services done for the sole purpose of blood samples or lab draw when the recipient
is able to access these services outside the home; and
(vi) Medicare evaluation or administrative nursing visits required by Medicare;
(3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education; deleted text begin and
deleted text end
(4) home care therapies provided in other settings such as a clinicdeleted text begin , day program,deleted text end or as
an inpatient or when the recipient can access therapy outside of the recipient's residencenew text begin ;
and
new text end
new text begin (5) home health agency services without qualifying documentation of a face-to-face
encounter as specified in subdivision 7new text end .
Minnesota Statutes 2016, section 256B.0653, is amended by adding a subdivision
to read:
new text begin
(a) A face-to-face encounter by a qualifying provider
must be completed for all home health services regardless of the need for prior authorization,
except when providing a onetime perinatal visit by skilled nursing. The face-to-face encounter
may occur through telemedicine as defined in section 256B.0625, subdivision 3b. The
encounter must be related to the primary reason the recipient requires home health services
and must occur within the 90 days before or the 30 days after the start of services. The
face-to-face encounter may be conducted by one of the following practitioners, licensed in
Minnesota:
new text end
new text begin
(1) a physician;
new text end
new text begin
(2) a nurse practitioner or clinical nurse specialist;
new text end
new text begin
(3) a certified nurse midwife; or
new text end
new text begin
(4) a physician assistant.
new text end
new text begin
(b) The allowed nonphysician practitioner, as described in this subdivision, performing
the face-to-face encounter must communicate the clinical findings of that face-to-face
encounter to the ordering physician. Those clinical findings must be incorporated into a
written or electronic document included in the recipient's medical record. To assure clinical
correlation between the face-to-face encounter and the associated home health services, the
physician responsible for ordering the services must:
new text end
new text begin
(1) document that the face-to-face encounter, which is related to the primary reason the
recipient requires home health services, occurred within the required time period; and
new text end
new text begin
(2) indicate the practitioner who conducted the encounter and the date of the encounter.
new text end
new text begin
(c) For home health services requiring authorization, including prior authorization, home
health agencies must retain the qualifying documentation of a face-to-face encounter as part
of the recipient health service record, and submit the qualifying documentation to the
commissioner or the commissioner's designee upon request.
new text end
Minnesota Statutes 2016, section 256B.0911, subdivision 1a, is amended to read:
For purposes of this section, the following definitions apply:
(a) Until additional requirements apply under paragraph (b), "long-term care consultation
services" means:
(1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;
(2) providing recommendations for and referrals to cost-effective community services
that are available to the individual;
(3) development of an individual's person-centered community support plan;
(4) providing information regarding eligibility for Minnesota health care programs;
(5) face-to-face long-term care consultation assessments, which may be completed in a
hospital, nursing facility, intermediate care facility for persons with developmental disabilities
(ICF/DDs), regional treatment centers, or the person's current or planned residence;
(6) determination of home and community-based waiver and other service eligibility as
required under sections 256B.0913, 256B.0915, and 256B.49, including level of care
determination for individuals who need an institutional level of care as determined under
subdivision 4e, based on assessment and community support plan development, appropriate
referrals to obtain necessary diagnostic information, and including an eligibility determination
for consumer-directed community supports;
(7) providing recommendations for institutional placement when there are no
cost-effective community services available;
(8) providing access to assistance to transition people back to community settings after
institutional admission; and
(9) providing information about competitive employment, with or without supports, for
school-age youth and working-age adults and referrals to the Disability Linkage Line and
Disability Benefits 101 to ensure that an informed choice about competitive employment
can be made. For the purposes of this subdivision, "competitive employment" means work
in the competitive labor market that is performed on a full-time or part-time basis in an
integrated setting, and for which an individual is compensated at or above the minimum
wage, but not less than the customary wage and level of benefits paid by the employer for
the same or similar work performed by individuals without disabilities.
(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 2c,
and 3a, "long-term care consultation services" also means:
(1) service eligibility determination for state plan home care services identified in:
(i) section 256B.0625, subdivisions 7, 19a, and 19c;
(ii) consumer support grants under section 256.476; or
(iii) section 256B.85;
(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
determination of eligibility for case management services available under sections 256B.0621,
subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part 9525.0016;
(3) determination of institutional level of care, home and community-based service
waiver, and other service eligibility as required under section 256B.092, determination of
eligibility for family support grants under section 252.32, semi-independent living services
under section 252.275, and day training and habilitation services under section 256B.092;
and
(4) obtaining necessary diagnostic information to determine eligibility under clauses (2)
and (3).
(c) "Long-term care options counseling" means the services provided by the linkage
lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and also
includes telephone assistance and follow up once a long-term care consultation assessment
has been completed.
(d) "Minnesota health care programs" means the medical assistance program under this
chapter and the alternative care program under section 256B.0913.
(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation assessment and
support planning services.
new text begin
(f) "Person-centered planning" is a process that includes the active participation of a
person in the planning of the person's services, including in making meaningful and informed
choices about the person's own goals, talents, and objectives, as well as making meaningful
and informed choices about the services the person receives. For the purposes of this section,
"informed choice" means a voluntary choice of services by a person from all available
service options based on accurate and complete information concerning all available service
options and concerning the person's own preferences, abilities, goals, and objectives. In
order for a person to make an informed choice, all available options must be developed and
presented to the person to empower the person to make decisions.
new text end
Minnesota Statutes 2016, section 256B.0911, subdivision 2b, is amended to read:
(a) Each lead agency shall use certified
assessors who have completed MnCHOICES training and the certification processes
determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
best practices in assessment and support planning including person-centered planning
deleted text begin principalsdeleted text end new text begin principlesnew text end and have a common set of skills that must ensure consistency and
equitable access to services statewide. A lead agency may choose, according to departmental
policies, to contract with a qualified, certified assessor to conduct assessments and
reassessments on behalf of the lead agency.new text begin Certified assessors must use person-centered
planning principles to conduct an interview that identifies what is important to the person,
the person's needs for supports, health and safety concerns, and the person's abilities, interests,
and goals.
new text end
new text begin
Certified assessors are responsible for:
new text end
new text begin
(1) ensuring persons are offered objective, unbiased access to resources;
new text end
new text begin
(2) ensuring persons have the needed information to support informed choice, including
where and how they choose to live and the opportunity to pursue desired employment;
new text end
new text begin
(3) determining level of care and eligibility for long-term services and supports;
new text end
new text begin
(4) using the information gathered from the interview to develop a person-centered
community support plan that reflects identified needs and support options within the context
of values, interests, and goals important to the person; and
new text end
new text begin
(5) providing the person with a community support plan that summarizes the person's
assessment findings, support options, and agreed-upon next steps.
new text end
(b) MnCHOICES certified assessors are persons with a minimum of a bachelor's degree
in social work, nursing with a public health nursing certificate, or other closely related field
with at least one year of home and community-based experience, or a registered nurse with
at least two years of home and community-based experience who has received training and
certification specific to assessment and consultation for long-term care services in the state.
Minnesota Statutes 2016, section 256B.0911, is amended by adding a subdivision
to read:
new text begin
Reassessments must be tailored using the professional judgment of the assessor to the
person's known needs, strengths, preferences, and circumstances. Reassessments provide
information to support the person's informed choice and opportunities to express choice
regarding activities that contribute to quality of life, as well as information and opportunity
to identify goals related to desired employment, community activities, and preferred living
environment. Reassessments allow for a review of the current support plan's effectiveness,
monitoring of services, and the development of an updated person-centered community
support plan. Reassessments verify continued eligibility or offer alternatives as warranted
and provide an opportunity for quality assurance of service delivery. Face-to-face assessments
must be conducted annually or as required by federal and state laws and rules.
new text end
Minnesota Statutes 2016, section 256B.0911, subdivision 4d, as amended by
Laws 2017, chapter 40, article 1, section 69, is amended to read:
(a) It is the
policy of the state of Minnesota to ensure that individuals with disabilities or chronic illness
are served in the most integrated setting appropriate to their needs and have the necessary
information to make informed choices about home and community-based service options.
(b) Individuals under 65 years of age who are admitted to a Medicaid-certified nursing
facility must be screened prior to admission according to the requirements outlined in section
256.975, subdivisions 7a to 7c. This shall be provided by the Senior LinkAge Line as
required under section 256.975, subdivision 7.
(c) Individuals under 65 years of age who are admitted to nursing facilities with only a
telephone screening must receive a face-to-face assessment from the long-term care
consultation team member of the county in which the facility is located or from the recipient's
county case manager within deleted text begin 40 calendar days of admissiondeleted text end new text begin the timeline established by the
commissioner, based on review of datanew text end .
(d) At the face-to-face assessment, the long-term care consultation team member or
county case manager must perform the activities required under subdivision 3b.
(e) For individuals under 21 years of age, a screening interview which recommends
nursing facility admission must be face-to-face and approved by the commissioner before
the individual is admitted to the nursing facility.
(f) In the event that an individual under 65 years of age is admitted to a nursing facility
on an emergency basis, the Senior LinkAge Line must be notified of the admission on the
next working day, and a face-to-face assessment as described in paragraph (c) must be
conducted within deleted text begin 40 calendar days of admissiondeleted text end new text begin the timeline established by the commissioner,
based on review of datanew text end .
(g) At the face-to-face assessment, the long-term care consultation team member or the
case manager must present information about home and community-based options, including
consumer-directed options, so the individual can make informed choices. If the individual
chooses home and community-based services, the long-term care consultation team member
or case manager must complete a written relocation plan within 20 working days of the
visit. The plan shall describe the services needed to move out of the facility and a time line
for the move which is designed to ensure a smooth transition to the individual's home and
community.
(h) An individual under 65 years of age residing in a nursing facility shall receive a
face-to-face assessment at least every 12 months to review the person's service choices and
available alternatives unless the individual indicates, in writing, that annual visits are not
desired. In this case, the individual must receive a face-to-face assessment at least once
every 36 months for the same purposes.
(i) Notwithstanding the provisions of subdivision 6, the commissioner may pay county
agencies directly for face-to-face assessments for individuals under 65 years of age who
are being considered for placement or residing in a nursing facility.
(j) Funding for preadmission screening follow-up shall be provided to the Disability
Linkage Line for the under-60 population by the Department of Human Services to cover
options counseling salaries and expenses to provide the services described in subdivisions
7a to 7c. The Disability Linkage Line shall employ, or contract with other agencies to
employ, within the limits of available funding, sufficient personnel to provide preadmission
screening follow-up services and shall seek to maximize federal funding for the service as
provided under section 256.01, subdivision 2, paragraph (aa).
Minnesota Statutes 2016, section 256B.0911, subdivision 5, is amended to read:
new text begin (a) new text end The commissioner shall streamline the processes,
including timelines for when assessments need to be completed, required to provide the
services in this section and shall implement integrated solutions to automate the business
processes to the extent necessary for community support plan approval, reimbursement,
program planning, evaluation, and policy development.
new text begin
(b) The commissioner of human services shall work with lead agencies responsible for
conducting long-term consultation services to modify the MnCHOICES application and
assessment policies to create efficiencies while ensuring federal compliance with medical
assistance and long-term services and supports eligibility criteria.
new text end
Minnesota Statutes 2016, section 256B.0911, subdivision 6, as amended by Laws
2017, chapter 40, article 1, section 70, is amended to read:
(a) Until September 30,
2013, payment for long-term care consultation face-to-face assessment shall be made as
described in this subdivision.
(b) The total payment for each county must be paid monthly by certified nursing facilities
in the county. The monthly amount to be paid by each nursing facility for each fiscal year
must be determined by dividing the county's annual allocation for long-term care consultation
services by 12 to determine the monthly payment and allocating the monthly payment to
each nursing facility based on the number of licensed beds in the nursing facility. Payments
to counties in which there is no certified nursing facility must be made by increasing the
payment rate of the two facilities located nearest to the county seat.
(c) The commissioner shall include the total annual payment determined under paragraph
(b) for each nursing facility reimbursed under section 256B.431, 256B.434, or chapter 256R.
(d) In the event of the layaway, delicensure and decertification, or removal from layaway
of 25 percent or more of the beds in a facility, the commissioner may adjust the per diem
payment amount in paragraph (c) and may adjust the monthly payment amount in paragraph
(b). The effective date of an adjustment made under this paragraph shall be on or after the
first day of the month following the effective date of the layaway, delicensure and
decertification, or removal from layaway.
(e) Payments for long-term care consultation services are available to the county or
counties to cover staff salaries and expenses to provide the services described in subdivision
1a. The county shall employ, or contract with other agencies to employ, within the limits
of available funding, sufficient personnel to provide long-term care consultation services
while meeting the state's long-term care outcomes and objectives as defined in subdivision
1. The county shall be accountable for meeting local objectives as approved by the
commissioner in the biennial home and community-based services quality assurance plan
on a form provided by the commissioner.
(f) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.
(g) The commissioner of human services shall amend the Minnesota medical assistance
plan to include reimbursement for the local consultation teams.
(h) Until the alternative payment methodology in paragraph (i) is implemented, the
county may bill, as case management services, assessments, support planning, and
follow-along provided to persons determined to be eligible for case management under
Minnesota health care programs. No individual or family member shall be charged for an
initial assessment or initial support plan development provided under subdivision 3a or 3b.
(i) The commissioner shall develop an alternative payment methodology, effective on
October 1, 2013, for long-term care consultation services that includes the funding available
under this subdivision, and for assessments authorized under sections 256B.092 and
256B.0659. In developing the new payment methodology, the commissioner shall consider
the maximization of other funding sources, including federal administrative reimbursement
through federal financial participation funding, for all long-term care consultation activity.
The alternative payment methodology shall include the use of the appropriate time studies
and the state financing of nonfederal share as part of the state's medical assistance program.new text begin
Between July 1, 2017, and June 30, 2019, the state shall pay 84.3 percent of the nonfederal
share as reimbursement to the counties. Beginning July 1, 2019, the state shall pay 81.9
percent of the nonfederal share as reimbursement to the counties.
new text end
Minnesota Statutes 2016, section 256B.0921, is amended to read:
The commissioner of human services shall develop an initiative to provide incentives
for innovation innew text begin : (1)new text end achieving integrated competitive employmentdeleted text begin ,deleted text end new text begin ; (2) achieving integrated
competitive employment for youth under age 25 upon their graduation from school; (3)new text end
living in the most integrated settingdeleted text begin ,deleted text end new text begin ;new text end and new text begin (4) new text end other outcomes determined by the commissioner.
The commissioner shall seek requests for proposals and shall contract with one or more
entities to provide incentive payments for meeting identified outcomes. deleted text begin The initial requests
for proposals must be issued by October 1, 2016.
deleted text end
Minnesota Statutes 2016, section 256B.4913, subdivision 4a, is amended to read:
(a) For purposes of this subdivision,
"implementation period" means the period beginning January 1, 2014, and ending on the
last day of the month in which the rate management system is populated with the data
necessary to calculate rates for substantially all individuals receiving home and
community-based waiver services under sections 256B.092 and 256B.49. "Banding period"
means the time period beginning on January 1, 2014, and ending upon the expiration of the
12-month period defined in paragraph (c), clause (5).
(b) For purposes of this subdivision, the historical rate for all service recipients means
the individual reimbursement rate for a recipient in effect on December 1, 2013, except
that:
(1) for a day service recipient who was not authorized to receive these waiver services
prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
changed providers on or after January 1, 2014, the historical rate must be the new text begin weighted
average new text end authorized rate for the provider new text begin number new text end in the county of service, effective December
1, 2013; or
(2) for a unit-based service with programming or a unit-based service without
programming recipient who was not authorized to receive these waiver services prior to
January 1, 2014; added a new service or services on or after January 1, 2014; or changed
providers on or after January 1, 2014, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or
(3) for residential service recipients who change providers on or after January 1, 2014,
the historical rate must be set by each lead agency within their county aggregate budget
using their respective methodology for residential services effective December 1, 2013, for
determining the provider rate for a similarly situated recipient being served by that provider.
(c) The commissioner shall adjust individual reimbursement rates determined under this
section so that the unit rate is no higher or lower than:
(1) 0.5 percent from the historical rate for the implementation period;
(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately
following the time period of clause (1);
(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately
following the time period of clause (2);
(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately
following the time period of clause (3);
(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately
following the time period of clause (4); deleted text begin and
deleted text end
(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
following the time period of clause (5). During this banding rate period, the commissioner
shall not enforce any rate decrease or increase that would otherwise result from the end of
the banding period. The commissioner shall, upon enactment, seek federal approval for the
addition of this banding periodnew text begin ; and
new text end
new text begin (7) one percent from the rate in effect in clause (6) for the 12-month period immediately
following the time period of clause (6)new text end .
(d) The commissioner shall review all changes to rates that were in effect on December
1, 2013, to verify that the rates in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013.
(e) By December 31, 2014, the commissioner shall complete the review in paragraph
(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.
(f) During the banding period, the Medicaid Management Information System (MMIS)
service agreement rate must be adjusted to account for change in an individual's need. The
commissioner shall adjust the Medicaid Management Information System (MMIS) service
agreement rate by:
(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the level of service in effect on December 1, 2013;
(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the updated level of service at the time of application;
and
(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
service agreement rate, the difference between the values in clauses (1) and (2).
(g) This subdivision must not apply to rates for recipients served by providers new to a
given county after January 1, 2014. Providers of personal supports services who also acted
as fiscal support entities must be treated as new providers as of January 1, 2014.
new text begin
(a) The amendment to paragraph (b) is effective the day following
final enactment.
new text end
new text begin
(b) The amendment to paragraph (c) is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Minnesota Statutes 2016, section 256B.4913, is amended by adding a subdivision
to read:
new text begin
A service added to section 256B.4914 after January 1, 2014, is
not subject to rate stabilization adjustment in this section.
new text end
new text begin
This section is effective the day following final enactment.
new text end
Minnesota Statutes 2016, section 256B.4914, subdivision 2, is amended to read:
(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
(b) "Commissioner" means the commissioner of human services.
(c) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.
(d) "Customized living tool" means a methodology for setting service rates that delineates
and documents the amount of each component service included in a recipient's customized
living service plan.
(e) "Disability waiver rates system" means a statewide system that establishes rates that
are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.
(f) "Individual staffing" means the time spent as a one-to-one interaction specific to an
individual recipient by staff to provide direct support and assistance with activities of daily
living, instrumental activities of daily living, and training to participants, and is based on
the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.
(g) "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.
(h) "Median" means the amount that divides distribution into two equal groups, one-half
above the median and one-half below the median.
(i) "Payment or rate" means reimbursement to an eligible provider for services provided
to a qualified individual based on an approved service authorization.
(j) "Rates management system" means a Web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.
(k) "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.
(l) "Shared staffing" means time spent by employees, not defined under paragraph (f),
providing or available to provide more than one individual with direct support and assistance
with activities of daily living as defined under section 256B.0659, subdivision 1, paragraph
(b); instrumental activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (i); ancillary activities needed to support individual services; and training to
participants, and is based on the requirements in each individual's coordinated service and
support plan under section 245D.02, subdivision 4b; any coordinated service and support
plan addendum under section 245D.02, subdivision 4c; an assessment tool; and provider
observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.
(m) "Staffing ratio" means the number of recipients a service provider employee supports
during a unit of service based on a uniform assessment tool, provider observation, case
history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.
(n) "Unit of service" means the following:
(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;
(2) for day services under subdivision 7:
(i) for day training and habilitation services, a unit of service is either:
(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or
(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and
(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;
(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;
(iii) for prevocational services, a unit of service is a day or an hour. A day unit of service
is six or more hours of time spent providing direct service;
(3) for unit-based services with programming under subdivision 8:
(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; and
(ii) for all other services, a unit of service is 15 minutes; and
(4) for unit-based services without programming under subdivision 9deleted text begin :
deleted text end
deleted text begin (i) for respite servicesdeleted text end , a unit of service is deleted text begin a day ordeleted text end 15 minutes. deleted text begin When a day rate is
authorized, any portion of a calendar day when an individual receives services is billable
as a day; and
deleted text end
deleted text begin
(ii) for all other services, a unit of service is 15 minutes.
deleted text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Minnesota Statutes 2016, section 256B.4914, subdivision 3, is amended to read:
Applicable services are those authorized under the state's
home and community-based services waivers under sections 256B.092 and 256B.49,
including the following, as defined in the federally approved home and community-based
services plan:
(1) 24-hour customized living;
(2) adult day care;
(3) adult day care bath;
(4) behavioral programming;
(5) companion services;
(6) customized living;
(7) day training and habilitation;
(8) housing access coordination;
(9) independent living skills;
(10) in-home family support;
(11) night supervision;
(12) personal support;
(13) prevocational services;
(14) residential care services;
(15) residential support services;
(16) respite services;
(17) structured day services;
(18) supported employment services;
(19) supported living services;
(20) transportation services; deleted text begin and
deleted text end
new text begin
(21) individualized home supports;
new text end
new text begin
(22) independent living skills specialist services;
new text end
new text begin
(23) employment exploration services;
new text end
new text begin
(24) employment development services;
new text end
new text begin
(25) employment support services; and
new text end
deleted text begin (21)deleted text end new text begin (26)new text end other services as approved by the federal government in the state home and
community-based services plan.
new text begin
(a) Clause (21) is effective the day following final enactment.
new text end
new text begin
(b) Clauses (22) to (25) are effective upon federal approval. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end
new text begin
(c) Clause (18) expires upon federal approval. The commissioner of human services
shall notify the revisor of statutes when federal approval is obtained.
new text end
Minnesota Statutes 2016, section 256B.4914, subdivision 5, is amended to read:
(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:
(1) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end
(SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); and 20 percent of the median wage for social and human
services aide (SOC code 21-1093); and
(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end (SOC code
deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 20 percent of the median wage for social and human services aide (SOC code
21-1093);
(2) for day services, 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end (SOC code
deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(3) for residential asleep-overnight staff, the wage deleted text begin will be $7.66 per hourdeleted text end new text begin is the minimum
wage in Minnesota for large employersnew text end , except in a family foster care setting, the wage is
deleted text begin $2.80 per hourdeleted text end new text begin 36 percent of the minimum wage in Minnesota for large employersnew text end ;
(4) for behavior program analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);
(5) for behavior program professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(6) for behavior program specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(7) for supportive living services staff, 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin
assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric
technician (SOC code 29-2053); and 60 percent of the median wage for social and human
services aide (SOC code 21-1093);
(8) for housing access coordination staff, deleted text begin 50deleted text end new text begin 100new text end percent of the median wage for
community and social services specialist (SOC code 21-1099);deleted text begin and 50 percent of the median
wage for social and human services aide (SOC code 21-1093);
deleted text end
(9) for in-home family support staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 30 percent of the median wage for community social service specialist
(SOC code 21-1099); 40 percent of the median wage for social and human services aide
(SOC code 21-1093); and ten percent of the median wage for psychiatric technician (SOC
code 29-2053);
(10) new text begin for individualized home supports services staff, 40 percent of the median wage for
community social service specialist (SOC code 21-1099); 50 percent of the median wage
for social and human services aide (SOC code 21-1093); and ten percent of the median
wage for psychiatric technician (SOC code 29-2053);
new text end
new text begin (11) new text end for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
new text begin
(12) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);
new text end
deleted text begin (11)deleted text end new text begin (13) new text end for supported employment staff, 20 percent of the median wage for nursing
deleted text begin aidedeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric
technician (SOC code 29-2053); and 60 percent of the median wage for social and human
services aide (SOC code 21-1093);
new text begin
(14) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
new text end
new text begin
(15) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
new text end
new text begin
(16) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);
new text end
deleted text begin (12)deleted text end new text begin (17)new text end for adult companion staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing deleted text begin aides,
orderlies, and attendantsdeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end );
deleted text begin (13)deleted text end new text begin (18)new text end for night supervision staff, 20 percent of the median wage for home health
aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
aide (SOC code 39-9021); 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end (SOC
code deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093);
deleted text begin (14)deleted text end new text begin (19)new text end for respite staff, 50 percent of the median wage for personal and home care
aide (SOC code 39-9021); and 50 percent of the median wage for nursing deleted text begin aides, orderlies,
and attendantsdeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end );
deleted text begin (15)deleted text end new text begin (20)new text end for personal support staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing deleted text begin aides,
orderlies, and attendantsdeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end );
deleted text begin (16)deleted text end new text begin (21)new text end for supervisory staff, deleted text begin the basic wage is $17.43 per hourdeleted text end new text begin , 100 percent of the
median wage for community and social services specialist (SOC code 21-1099),new text end with new text begin the
new text end exception of the supervisor of behavior new text begin professional, behavior new text end analystnew text begin ,new text end and behavior
specialists, which deleted text begin must be $30.75 per hourdeleted text end new text begin is 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031)new text end ;
deleted text begin (17)deleted text end new text begin (22)new text end for registered nursenew text begin staffnew text end , deleted text begin the basic wage is $30.82 per hourdeleted text end new text begin , 100 percent of
the median wage for registered nurses (SOC code 29-1141)new text end ; and
deleted text begin (18)deleted text end new text begin (23)new text end for licensed practical nursenew text begin staffnew text end , deleted text begin the basic wage is $18.64 per hourdeleted text end new text begin 100 percent
of the median wage for licensed practical nurses (SOC code 29-2061)new text end .
(b) Component values for residential support services are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) general administrative support ratio: 13.25 percent;
(5) program-related expense ratio: 1.3 percent; and
(6) absence and utilization factor ratio: 3.9 percent.
(c) Component values for family foster care are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) general administrative support ratio: 3.3 percent;
(5) program-related expense ratio: 1.3 percent; and
(6) absence factor: 1.7 percent.
(d) Component values for day services for all services are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) program plan support ratio: 5.6 percent;
(5) client programming and support ratio: ten percent;
(6) general administrative support ratio: 13.25 percent;
(7) program-related expense ratio: 1.8 percent; and
(8) absence and utilization factor ratio: deleted text begin 3.9deleted text end new text begin 9.4new text end percent.
(e) Component values for unit-based services with programming are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) program plan supports ratio: deleted text begin 3.1deleted text end new text begin 15.5new text end percent;
(5) client programming and supports ratio: deleted text begin 8.6deleted text end new text begin 4.7new text end percent;
(6) general administrative support ratio: 13.25 percent;
(7) program-related expense ratio: 6.1 percent; and
(8) absence and utilization factor ratio: 3.9 percent.
(f) Component values for unit-based services without programming except respite are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) program plan support ratio: deleted text begin 3.1deleted text end new text begin 7.0new text end percent;
(5) client programming and support ratio: deleted text begin 8.6deleted text end new text begin 2.3new text end percent;
(6) general administrative support ratio: 13.25 percent;
(7) program-related expense ratio: deleted text begin 6.1deleted text end new text begin 2.9new text end percent; and
(8) absence and utilization factor ratio: 3.9 percent.
(g) Component values for unit-based services without programming for respite are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) general administrative support ratio: 13.25 percent;
(5) program-related expense ratio: deleted text begin 6.1deleted text end new text begin 2.9new text end percent; and
(6) absence and utilization factor ratio: 3.9 percent.
(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system. deleted text begin This adjustment occurs every five
years. For adjustments in 2021 and beyond, the commissioner shall use the data available
on December 31 of the calendar year five years prior.deleted text end new text begin On July 1, 2022, and every five years
thereafter, the commissioner shall update the base wage index in paragraph (a) based on
the most recently available wage data by SOC from the Bureau of Labor Statistics. The
commissioner shall publish these updated values and load them into the rate management
system.
new text end
(i) On July 1, 2017, the commissioner shall update the framework components in
deleted text begin paragraphs (b) to (g)deleted text end new text begin paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f),
clause (5)new text end ; subdivision 6, clauses (8) and (9); and subdivision 7, clauses new text begin (10), new text end (16)new text begin ,new text end and (17),
for changes in the Consumer Price Index. The commissioner will adjust these values higher
or lower by the percentage change in the Consumer Price Index-All Items, United States
city average (CPI-U) from January 1, 2014, to January 1, 2017. The commissioner shall
publish these updated values and load them into the rate management system. deleted text begin This adjustment
occurs every five years. For adjustments in 2021 and beyond, the commissioner shall use
the data available on January 1 of the calendar year four years prior and January 1 of the
current calendar year.deleted text end new text begin On July 1, 2022, and every five years thereafter, the commissioner
shall update the framework components in paragraph (d), clause (5); paragraph (e), clause
(5); and paragraph (f), clause (5); subdivision 6, clauses (8) and (9); and subdivision 7,
clauses (10), (16), and (17), for changes in the Consumer Price Index. The commissioner
shall adjust these values higher or lower by the percentage change in the CPI-U from the
date of the previous update to the date of the data most recently available prior to the
scheduled update. The commissioner shall publish these updated values and load them into
the rate management system.
new text end
new text begin
(j) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.
new text end
new text begin
(a) The amendments to paragraphs (a) to (g) are effective January
1, 2018, except the amendment to paragraph (a), clauses (3), (21), and (22), and paragraph
(d), clause (8), which are effective January 1, 2019, and the amendment to paragraph (a),
clause (10), which is effective the day following final enactment.
new text end
new text begin
(b) The amendments to paragraphs (h) to (j) are effective the day following final
enactment.
new text end
new text begin
(c) Paragraph (a), clause (13), expires upon federal approval. The commissioner of
human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Minnesota Statutes 2016, section 256B.4914, subdivision 6, is amended to read:
(a) Payments for residential support
services, as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
must be calculated as follows:
(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5. This is defined as the direct-care rate;
(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;
(4) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages in
subdivision 5, paragraph (a), or the customized direct-care rate;
(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin (16)deleted text end new text begin (21)new text end ;
(6) combine the results of clauses (4) and (5), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (2). This is defined as the direct staffing cost;
(7) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
(8) for client programming and supports, the commissioner shall add $2,179; and
(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.
(b) The total rate must be calculated using the following steps:
(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (7);
(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(c) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.
(d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
meet or exceed the days of service used to convert service agreements in effect on December
1, 2013, and must not result in a reduction in spending or service utilization due to conversion
during the implementation period under section 256B.4913, subdivision 4a. If during the
implementation period, an individual's historical rate, including adjustments required under
section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.
(e) The number of days authorized for all individuals enrolling after January 1, 2014,
in residential services must include every day that services start and end.
Minnesota Statutes 2016, section 256B.4914, subdivision 7, is amended to read:
Payments for services with day programs
including adult day care, day treatment and habilitation, prevocational services, and structured
day services must be calculated as follows:
(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and
(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;
(4) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage in subdivision 5, paragraph (a), or the customized direct-care rate;
(5) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin (16)deleted text end new text begin (21)new text end ;
(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(2). This is defined as the direct staffing rate;
(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (4);
(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
(10) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs;
(11) for adult day bath services, add $7.01 per 15 minute unit;
(12) this is the subtotal rate;
(13) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(14) divide the result of clause (12) by one minus the result of clause (13). This is the
total payment amount;
(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;
(16) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:
(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;
(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;
(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or
(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;
(17) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:
(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;
(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or
(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.
Minnesota Statutes 2016, section 256B.4914, subdivision 8, is amended to read:
Payments for unit-based
services with programming, including behavior programming, housing access coordination,
in-home family support, independent living skills training, new text begin independent living skills specialist
services, individualized home supports, new text end hourly supported living services, new text begin employment
exploration services, employment development services, supported employment, new text end and
deleted text begin supporteddeleted text end employment new text begin support services new text end provided to an individual outside of any day or
residential service plan must be calculated as follows, unless the services are authorized
separately under subdivision 6 or 7:
(1) determine the number of units of service to meet a recipient's needs;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;
(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a), or the customized direct-care rate;
(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin (16)deleted text end new text begin (21)new text end ;
(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), clause
(2). This is defined as the direct staffing rate;
(7) for program plan support, multiply the result of clause (6) by one plus the program
plan supports ratio in subdivision 5, paragraph (e), clause (4);
(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
(10) this is the subtotal rate;
(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;
(13) for supported employment provided in a shared manner, divide the total payment
amount in clause (12) by the number of service recipients, not to exceed three. new text begin For
employment support services provided in a shared manner, divide the total payment amount
in clause (12) by the number of service recipients, not to exceed six. new text end For independent living
skills training new text begin and individualized home supports new text end provided in a shared manner, divide the
total payment amount in clause (12) by the number of service recipients, not to exceed two;
and
(14) adjust the result of clause (13) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin
This section is effective the day following final enactment.
Supported employment services in this subdivision expire upon federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Minnesota Statutes 2016, section 256B.4914, subdivision 9, is amended to read:
Payments for
unit-based services without programming, including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivision 6 or 7:
(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5 or the customized direct care rate;
(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin (16)deleted text end new text begin (21)new text end ;
(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
(2). This is defined as the direct staffing rate;
(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (f), clause (4);
(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
(10) this is the subtotal rate;
(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;
(13) for respite services, determine the number of day units of service to meet an
individual's needs;
(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(15) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (14). This
is defined as the customized direct care rate;
(16) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a);
(17) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause deleted text begin (16)deleted text end new text begin (21)new text end ;
(18) combine the results of clauses (16) and (17), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
clause (2). This is defined as the direct staffing rate;
(19) for employee-related expenses, multiply the result of clause (18) by one plus the
employee-related cost ratio in subdivision 5, paragraph (g), clause (3);
(20) this is the subtotal rate;
(21) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(22) divide the result of clause (20) by one minus the result of clause (21). This is the
total payment amount; and
(23) adjust the result of clauses (12) and (22) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.
Minnesota Statutes 2016, section 256B.4914, subdivision 10, is amended to read:
(a) From January
1, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
procedures to refine terms and adjust values used to calculate payment rates in this section.
(b) No later than July 1, 2014, the commissioner shall, within available resources, begin
to conduct research and gather data and information from existing state systems or other
outside sources on the following items:
(1) differences in the underlying cost to provide services and care across the state; and
(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and
(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.
(c) new text begin Beginning January 1, 2014, through December 31, 2018, new text end using a statistically valid
set of rates management system data, the commissioner, in consultation with stakeholders,
shall analyze for each service the average difference in the rate on December 31, 2013, and
the framework rate at the individual, provider, lead agency, and state levels. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a. The commissioner shall issue the first report by October 1, 2014new text begin , and the final report
shall be issued by December 31, 2018new text end .
(d) No later than July 1, 2014, the commissioner, in consultation with stakeholders, shall
begin the review and evaluation of the following values already in subdivisions 6 to 9, or
issues that impact all services, including, but not limited to:
(1) values for transportation rates deleted text begin for day servicesdeleted text end ;
deleted text begin
(2) values for transportation rates in residential services;
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end values for services where monitoring technology replaces staff time;
deleted text begin (4)deleted text end new text begin (3)new text end values for indirect services;
deleted text begin (5)deleted text end new text begin (4)new text end values for nursing;
deleted text begin
(6) component values for independent living skills;
deleted text end
deleted text begin
(7) component values for family foster care that reflect licensing requirements;
deleted text end
deleted text begin
(8) adjustments to other components to replace the budget neutrality factor;
deleted text end
deleted text begin
(9) remote monitoring technology for nonresidential services;
deleted text end
deleted text begin
(10) values for basic and intensive services in residential services;
deleted text end
deleted text begin (11)deleted text end new text begin (5)new text end values for the facility use rate in day services, and the weightings used in the
day service ratios and adjustments to those weightings;
deleted text begin (12)deleted text end new text begin (6)new text end values for workers' compensation as part of employee-related expenses;
deleted text begin (13)deleted text end new text begin (7)new text end values for unemployment insurance as part of employee-related expenses;
deleted text begin
(14) a component value to reflect costs for individuals with rates previously adjusted
for the inclusion of group residential housing rate 3 costs, only for any individual enrolled
as of December 31, 2013; and
deleted text end
deleted text begin (15)deleted text end new text begin (8)new text end any changes in state or federal law with deleted text begin andeleted text end new text begin a directnew text end impact on the underlying
cost of providing home and community-based servicesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(9) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section.
new text end
(e) The commissioner shall report to the chairs and the ranking minority members of
the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs (b) to (d) on
the following dates:
(1) January 15, 2015, with preliminary results and data;
(2) January 15, 2016, with a status implementation update, and additional data and
summary information;
(3) January 15, 2017, with the full report; and
(4) January 15, deleted text begin 2019deleted text end new text begin 2020new text end , with another full report, and a full report once every four
years thereafter.
deleted text begin
(f) Based on the commissioner's evaluation of the information and data collected in
paragraphs (b) to (d), the commissioner shall make recommendations to the legislature by
January 15, 2015, to address any issues identified during the first year of implementation.
After January 15, 2015, the commissioner may make recommendations to the legislature
to address potential issues.
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end The commissioner shall implement a regional adjustment factor to all rate
calculations in subdivisions 6 to 9, effective no later than January 1, 2015. new text begin Beginning July
1, 2017, the commissioner shall renew analysis and implement changes to the regional
adjustment factors when adjustments required under subdivision 5, paragraph (h), occur.
new text end Prior to implementation, the commissioner shall consult with stakeholders on the
methodology to calculate the adjustment.
deleted text begin (h)deleted text end new text begin (g)new text end The commissioner shall provide a public notice via LISTSERV in October of
each year beginning October 1, 2014, containing information detailing legislatively approved
changes in:
(1) calculation values including derived wage rates and related employee and
administrative factors;
(2) service utilization;
(3) county and tribal allocation changes; and
(4) information on adjustments made to calculation values and the timing of those
adjustments.
The information in this notice must be effective January 1 of the following year.
deleted text begin
(i) No later than July 1, 2016, the commissioner shall develop and implement, in
consultation with stakeholders, a methodology sufficient to determine the shared staffing
levels necessary to meet, at a minimum, health and welfare needs of individuals who will
be living together in shared residential settings, and the required shared staffing activities
described in subdivision 2, paragraph (l). This determination methodology must ensure
staffing levels are adaptable to meet the needs and desired outcomes for current and
prospective residents in shared residential settings.
deleted text end
deleted text begin (j)deleted text end new text begin (h)new text end When the available shared staffing hours in a residential setting are insufficient
to meet the needs of an individual who enrolled in residential services after January 1, 2014,
or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f), then individual staffing hours
shall be used.
new text begin
(i) The commissioner shall study the underlying cost of absence and utilization for day
services. Based on the commissioner's evaluation of the data collected under this paragraph,
the commissioner shall make recommendations to the legislature by January 15, 2018, for
changes, if any, to the absence and utilization factor ratio component value for day services.
new text end
new text begin
(j) Beginning July 1, 2017, the commissioner shall collect transportation and trip
information for all day services through the rates management system.
new text end
new text begin
This section is effective the day following final enactment.
new text end
Minnesota Statutes 2016, section 256B.4914, is amended by adding a subdivision
to read:
new text begin
(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to 9 reflect the cost to provide the
service. As determined by the commissioner, in consultation with stakeholders identified
in section 256B.4913, subdivision 5, a provider enrolled to provide services with rates
determined under this section must submit requested cost data to the commissioner to support
research on the cost of providing services that have rates determined by the disability waiver
rates system. Requested cost data may include, but is not limited to:
new text end
new text begin
(1) worker wage costs;
new text end
new text begin
(2) benefits paid;
new text end
new text begin
(3) supervisor wage costs;
new text end
new text begin
(4) executive wage costs;
new text end
new text begin
(5) vacation, sick, and training time paid;
new text end
new text begin
(6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end
new text begin
(7) administrative costs paid;
new text end
new text begin
(8) program costs paid;
new text end
new text begin
(9) transportation costs paid;
new text end
new text begin
(10) vacancy rates; and
new text end
new text begin
(11) other data relating to costs required to provide services requested by the
commissioner.
new text end
new text begin
(b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
<